Ivo Kunovski

@ukim.mk

Ss Cyril and Methodius University Skopje
University Clinic of Psychiatry

Ivo Kunovski


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https://researchid.co/ivokunovski

RESEARCH, TEACHING, or OTHER INTERESTS

Psychiatry and Mental health, Clinical Psychology, Health Policy
7

Scopus Publications

329

Scholar Citations

5

Scholar h-index

4

Scholar i10-index

Scopus Publications

  • Six-country psychometric comparison of women responses to the Depression Anxiety Stress Scale (DASS) and the Child and Adolescent Behaviour Inventory (CABI) across cultures and time
    Francisco Antonio Calderón Alfaro, Jamie Lachman, Catherine L. Ward, Qing Han, Rosanne Jocson, Ivo Kunovski, Stephanie Eagling-Peche, Rumaya Juhari, Kufre Okop, Jennel Reyes, Viorel Babii, Lucie Cluver, Liane Peña Alampay, Marija Raleva, Frances Gardner
    Journal of Affective Disorders, 2025
    BACKGROUND: The Depression Anxiety Stress Scale (DASS) and the Child and Adolescent Behaviour Inventory (CABI) are freely accessible tools used to assess depression and externalizing symptoms, respectively. There is limited psychometric evidence on how these scales hold over time and across cultures. This study aims to evaluate the internal structure of both scales and their invariance across six countries and over two timepoints. METHODS: Data from the ParentChat Pilot Study included information from 566 adults (85.51 % female) with children aged 2 to 17. Only female data from North Macedonia, Malaysia, Moldova, Montenegro, Philippines, and South Africa were used. Confirmatory factor analysis was employed to assess invariance of each construct. RESULTS: At baseline, the DASS depression subscale achieved scalar invariance across five countries (CFI = 0.973, TLI = 0.956, RMSEA = 0.060, SRMR = 0.069) and across timepoints (CFI = 0.990, TLI = 0.979, RMSE = 0.037, SRMR = 0.034). The CABI extract achieved scalar invariance across two countries (CFI = 0.968, TLI = 0.963, RMSEA = 0.068, SRMR = 0.085) and across timepoints (CFI = 0.983, TLI = 0.980, RMSEA = 0.044, SRMR = 0.067). LIMITATIONS: Small sample sizes, disproportionate female sample, and use of subscales or item extracts may limit generalizability. The scales were also not validated for all age groups used. CONCLUSIONS: The study provides evidence of validity for the internal structure of the DASS and CABI extracts across cultures and over time. These findings support the use of these open-access tools in resource-limited settings to promote local research.
  • Family-focused intervention programme to foster adolescent mental health and well-being: protocol for a multicountry cluster randomised factorial trial (FLOURISH Phase 2)
    Antonio Piolanti, Janina Mueller, Franziska Waller, Nina Heinrichs, Judit Simon, Yulia Shenderovich, Swetha Sampathkumar, Dennis Wienand, Marija Raleva, Ivo Kunovski, Viorel Babii, Xiang Zhao, Graham Moore, Heather M Foran
    BMJ Open, 2025
    Introduction Adolescent mental health problems represent a significant global health issue, particularly in low- and middle-income countries, such as the Republic of North Macedonia and the Republic of Moldova. Effective and scalable interventions are urgently needed to address these challenges. Methods and analysis This protocol outlines a multicountry cluster randomised factorial trial, implemented according to the multiphase optimisation strategy (Phase 2), which evaluates the effectiveness and costs of three add-on components for the Parenting for Lifelong Health for Parents and Teens programme: adolescent mental health tools based on UNICEFs Helping Adolescents Thrive comics, adolescent peer support based on UNICEFs ‘I Support My Friends’ intervention and engagement booster designed to enhance attendance and programme completion through incentives. The study will recruit 720 families and involve 64 clusters in North Macedonia and Moldova. Primary outcomes will include adolescent internalising problems and social support, family functioning and attendance during the programme. Secondary outcomes will assess broader aspects of mental health among caregivers and adolescents, as well as implementation and cost outcomes. Data will be collected at baseline and postintervention, approximately, 8 weeks later. Statistical analyses will include regression models to assess the main and interaction effects of the intervention components and cost analyses. Ethics and dissemination The study received ethical approval from the University of Klagenfurt in Austria (approval number: 2023–013), the Medical Faculty at St. Cyril and Methodius University in North Macedonia (approval number: 03-2144/4) and the National Committee of Ethical Expertise for Clinical Trials in Moldova (approval number: 1476). The results will be disseminated through peer-reviewed journals, conferences, webinars in multiple languages, regional forums, stakeholder meetings with policymakers and practitioners, public communication through media engagement and open access platforms, including data sharing and early release of findings. Trial registration details Trial registration: NCT06562244 ; Project page: https://www.flourish-study.org/about.html
  • Adverse event assessment in a parenting programme: experiences from a multisite randomised controlled trial
    Inga Frantz, Heather M. Foran, Jamie M. Lachman, Frances Gardner, Robert J. McMahon, Terje Ogden, Judy Hutchings, Madalina Ruxandra Costin, Ivo Kunovski, Marija Raleva, Janina Mueller, Nina Heinrichs
    Trials, 2024
    Background Clinicians and researchers should consider the expected benefits and potential harms of an intervention. Parenting programmes are a widely used evidence-based intervention for child behaviour problems. However, few data are available on potential negative effects. The aims of this paper were to increase systematic knowledge of adverse event (AE) assessment in parenting programmes and to provide an AE assessment tool. Methods As part of the RISE project (prevention of child mental health problems in South-eastern Europe—adapt, optimise, test and extend parenting for lifelong health), we developed and tested an AE assessment procedure in three sequential studies for parents of children with child behaviour problems aged 2 to 9 years in North Macedonia, Republic of Moldova, and Romania. This paper reports on the development of the assessment tool in phase 1 (N = 140), phase 2 (N = 835), and the final experiences with using the optimised procedures in phase 3 (multisite randomised controlled trial, N = 823) in which AEs were assessed before, three times during intervention delivery, and at 1 year follow-up. At each time point, the participants completed a 12-item AE checklist. If moderate-to-severe problems of parent or child were reported, a structured follow-up interview was conducted. Results The response rate on the AE assessment tool increased from 6% (phase 1) to 100% (phase 3) indicating improvement in collecting these data based on the experiences of each phase. Results of the RCT (phase 3) showed generally low (S)AE frequencies with the finally optimised procedure: During the intervention, no serious adverse events (SAE) were registered; at least one AE was reported by 10% (after the first session), 7% (after the third session), and 4% (after the last fifth session) of participants. None of the identified (S)AEs was causally related to the study or intervention. Cost–benefit considerations are needed to determine the best way to ensure participant safety in parenting programmes. Conclusion The applied active AE assessment procedure provides a comprehensive AE assessment tool that can be used by others—with adaptations for the specific context, if needed. Based on our experiences, we outline recommendations for future studies. Trial registration ClinicalTrials.gov, registration number phase 1: NCT03552250; phase 2: NCT03865485, phase 3: NCT04721730. Registered on 13 January 2021.
  • The bidirectional temporal relationship between parenting stress and child maltreatment: A cross-lagged study based on intervention and cohort data
    Qing Han, Rosanne Jocson, Ivo Kunovski, Marija Raleva, Rumaya Juhari, Kufre Okop, Annathea Oppler, Katherine Wilson, Tanja Cirovic, Hlengiwe Sacolo Gwebu, Liane Alampay, Stephanie Eagling-Peche, Francisco Calderon, Inge Vallance, Fadhil Muharam, Yuanling Chen, Jamie Lachman
    Journal of Affective Disorders, 2024
    BACKGROUND: Parenting stress has long been proposed as a major risk factor for child maltreatment. However, there is a lack of evidence from existing studies on the temporal sequence to establish a causal relationship. This study aims to examine bidirectional temporal relationships between parenting stress and child maltreatment. METHODS: Longitudinal data from two different sources were analysed: a pre-post study of an online parenting programme conducted across six countries - the ePLH Evaluation Study, and a prospective cohort study in the United States - LONGSCAN. Cross-lagged panel model on parenting stress and child maltreatment was used in each dataset. RESULTS: Based on repeatedly measured data of 484 caregivers in the ePLH study across five time points (every two weeks), we found that parenting stress at an earlier time point predicted later child maltreatment (IRR = 1.14, 95 % CI: 1.10,1.18). In addition, the occurrence of child maltreatment was associated with higher subsequent short-term parenting stress (IRR = 1.04, 95 % CI: 1.01,1.08) and thus could form a vicious circle. In the LONGSCAN analysis with 772 caregivers who were followed up from child age of 6 to child age of 16, we also found parenting stress at an earlier time point predicted later child maltreatment (β = 0.11, 95 % CI: 0.01,0.20), but did not observe an association between child maltreatment and subsequent long-term parenting stress. LIMITATIONS: Potential information bias on the measurements. CONCLUSIONS: This study provides evidence for a bidirectional temporal relationship between parenting stress and child maltreatment, which should be considered in parenting intervention programmes.
  • Factor structure of the Depression, Anxiety and Stress Scale among caregivers in Southeastern Europe
    Hugh Murphy, Katharina Prandstetter, Catherine L. Ward, Judy Hutchings, Ivo Kunovski, Diana Tăut, Heather M. Foran
    Family Relations, 2024
    ObjectiveThis study aimed to evaluate the factor structure of the Depression Anxiety and Stress Scale (DASS‐21) among caregivers of young children in Southeastern Europe.BackgroundThe DASS‐21 is a widely used measure in prevention and intervention research with families. Studies regarding the scale's psychometric properties among caregivers, particularly from non‐Western countries, are limited and additional research is required.MethodThe DASS‐21 was administered to N = 835 primary caregivers from North Macedonia, the Republic of Moldova, and Romania. Competing models were tested with confirmatory factor analysis (CFA). Measurement invariance was assessed using multigroup CFA (MGCFA). Bifactor dimensionality and reliability indices were used to evaluate the validity of the composite and subscale scores.ResultsA tripartite bifactor model with two specific factors (depression and anxiety) and one general factor (negative affectivity) represented the data well. This model showed cross‐country configural and partial metric invariance. Dimensionality and reliability indices supported a unidimensional interpretation of the measure, with the general negative affectivity factor accounting for a substantial share of the variance (82%) compared to the specific factors of depression (10%) and anxiety (8%).ConclusionThe tripartite model best represented the data. Configural and partial metric invariance were verified for this model. Dimensionality and reliability indices, however, indicate that the DASS‐21 functions best as a general measure of negative affectivity.ImplicationsFuture intervention studies involving caregivers from Southeastern Europe should consider using the DASS‐21 as an overall measure of negative affectivity and utilize the composite score instead of the subscale scores.
  • Internet-delivered cognitive behavioral therapy for posttraumatic stress disorder in international humanitarian aid workers: Study protocol
    Ivo Kunovski, Tara Donker, Ellen Driessen, Pim Cuijpers, Gerhard Andersson, Marit Sijbrandij
    Internet Interventions, 2017
    BACKGROUND: Humanitarian aid workers are likely to be exposed or witness complex emergencies. Posttraumatic stress disorder (PTSD) is one of the most widespread and most commonly studied mental health problems after exposure to adversities and trauma. However, face-to-face treatment has limited utilization in the resource-constrained settings where humanitarian aid workers often operate. Internet-delivered cognitive behavioral therapy (iCBT) is a treatment option with the potential to improve the access to evidence-based care for humanitarian aid workers. Until now, only a few studies have evaluated iCBT in the treatment of PTSD. No studies have yet explored the feasibility of iCBT for humanitarian aid workers with PTSD. The aim of this study is to investigate the participants' experiences and progress with the treatment, in order to determine whether TELLUS is acceptable for humanitarian aid workers. METHODS AND DESIGN: A pilot feasibility study will be conducted with 20 humanitarian aid workers with a full or subclinical PTSD diagnosis according to DSM-IV criteria. The intervention used is TELLUS, which is a therapist-assisted Internet-delivered treatment program based on trauma-focused CBT components for individuals with PTSD. It contains eight text-based modules, where each module is expected to be completed within one week. DISCUSSION: This study may set the ground for a large-scale randomized control trial that would test the effectiveness and cost-effectiveness of the program. The study may contribute to the better understanding of PTSD treatment and increase the availability of evidence-based treatments in resource-constrained settings.
  • EFFECTIVENESS OF INTERNET-DELIVERED COGNITIVE BEHAVIORAL THERAPY FOR POSTTRAUMATIC STRESS DISORDER: A SYSTEMATIC REVIEW AND META-ANALYSIS
    Marit Sijbrandij, Ivo Kunovski, Pim Cuijpers
    Depression and Anxiety, 2016
    BACKGROUND: Internet-delivered cognitive behavioral therapy (iCBT) is a relatively novel treatment method that may improve the accessibility of mental health care for individuals with posttraumatic stress disorder (PTSD). The aim of this meta-analysis was to evaluate the effectiveness of iCBT compared to inactive (waitlist control and treatment-as-usual (TAU)) and active other interventions in reducing PTSD symptoms. METHODS: A meta-analysis of 12 randomized controlled trials (14 comparisons) and 1,306 participants was conducted. RESULTS: The pooled effect size of the 11 comparisons (10 studies, 1,139 participants) that compared iCBT to waitlist and TAU control was moderate (g = 0.71, 95% CI [0.49-0.93], P < .001), and showed moderate heterogeneity. The pooled effect size of the three studies (three comparisons) comparing iCBT to other interventions was small (g = 0.28, 95% CI [-0.00 to 0.56], P = .05), with low heterogeneity. CONCLUSION: The findings of this systematic review and meta-analysis show that iCBT is an effective treatment for individuals with PTSD and comorbid depressive symptoms. However, further research is needed for effective dissemination of iCBT in clinical practice.

RECENT SCHOLAR PUBLICATIONS

  • Six-country psychometric comparison of women responses to the Depression Anxiety Stress Scale (DASS) and the Child and Adolescent Behaviour Inventory (CABI) across cultures and …
    FAC Alfaro, J Lachman, CL Ward, Q Han, R Jocson, I Kunovski, ...
    Journal of Affective Disorders 387, 119524 , 2025
    2025.0
  • Does it get worse before it gets better? Outcomes from a parent-adolescen parenting program in North Macedonia
    I Kunovski, M Raleva, N Pachoska, M Bilinska, R Krsteska, ...
    2025.0
  • Family-focused intervention programme to foster adolescent mental health and well-being: protocol for a multicountry cluster randomised factorial trial (FLOURISH Phase 2)
    A Piolanti, J Mueller, F Waller, N Heinrichs, J Simon, Y Shenderovich, ...
    BMJ open 15 (2), e094085 , 2025
    2025.0
    Citations: 1
  • Provisional
    A Piolanti, J Mueller, F Waller, N Heinrichs, J Simon, Y Shenderovich, ...
    2024.0
  • Adverse event assessment in a parenting programme: experiences from a multisite randomised controlled trial
    I Frantz, HM Foran, JM Lachman, F Gardner, RJ McMahon, T Ogden, ...
    Trials 25 (1), 547 , 2024
    2024.0
    Citations: 4
  • The bidirectional temporal relationship between parenting stress and child maltreatment: A cross-lagged study based on intervention and cohort data
    Q Han, R Jocson, I Kunovski, M Raleva, R Juhari, K Okop, A Oppler, ...
    Journal of affective disorders 354, 302-308 , 2024
    2024.0
    Citations: 20
  • Factor structure of the Depression, Anxiety and Stress Scale among caregivers in Southeastern Europe
    H Murphy, K Prandstetter, CL Ward, J Hutchings, I Kunovski, D Tăut, ...
    Family Relations 73 (2), 905-920 , 2024
    2024.0
    Citations: 17
  • Effectiveness of an online parenting program for childhood anxiety in North Macedonia
    I Kunovski, M Raleva
    Archives of Public Health 15 (2) , 2023
    2023.0
    Citations: 1
  • COPING STYLES AND MENTAL HEALTH IN HEALTHCARE WORKERS DURING THE COVID-19 PANDEMIC
    I Kunovski, S Bajraktarov, V Isjanovski
    Academic Medical Journal 3 (3), 30-40 , 2023
    2023.0
  • Depression and anxiety in adolescents and their caregivers: A cross-sectional study from North Macedonia
    S Bajraktarov, I Kunovski, M Raleva, F Bolinski, R Isjanovska, G Kalpak, ...
    Prilozi 44 (1), 47-56 , 2023
    2023.0
    Citations: 7
  • Symptoms of depression and anxiety in adolescents and their caregivers: A cross-sectional study from North Macedonia
    I Kunovski, F Bolinski, M Raleva, R Isjanovska, G Kalpak, A Novotni, ...
    European Psychiatry 66 (Suppl 1), S201-S201 , 2023
    2023.0
  • Preventing Child Maltreatment and Promoting Family Wellbeing through Online Parent Support Groups in Six Countries
    Q Han, J Lachman, R Juhari, I Ferdinandi, M Raleva, R Jocson, ...
    Society for Prevention Research 30th Annual Meeting , 2022
    2022.0
  • Online Implementation of a Parenting Intervention for Parents of Children with Behavioural Problems: Implementation Data from a Multi-Site RCT in Southeastern Europe (RISE)
    D Taut, J Hutchings, A Baban, C Ward, N Heinrichs, H Foran, F Gardner, ...
    Society for Prevention Research 30th Annual Meeting , 2022
    2022.0
  • Effects of childhood abuse and neglect on suicidal behavior in an adolescent clinical population
    I Kunovski, G Nikolova, A Filipovska, L Trpcevska, M Raleva
    European psychiatry 56, S65-S66 , 2019
    2019.0
    Citations: 12
  • Internet-delivered cognitive behavioral therapy for posttraumatic stress disorder in international humanitarian aid workers: Study protocol
    I Kunovski, T Donker, E Driessen, P Cuijpers, G Andersson, M Sijbrandij
    Internet interventions 10, 23-28 , 2017
    2017.0
    Citations: 2
  • Effectiveness of internet‐delivered cognitive behavioral therapy for posttraumatic stress disorder: A systematic review and meta‐analysis
    M Sijbrandij, I Kunovski, P Cuijpers
    Depression and anxiety 33 (9), 783-791 , 2016
    2016.0
    Citations: 265
  • Parental Support through Promoting the Concept of Positive Parenting
    N Petrovska, NS Trajkovska, I Kunovski, AK Ristovska, S Georgievska, ...
    CONFERENCE PROCEEDINGS of the 1st International Conference–Challenges of … , 0
  • Family Functioning in low-resource settings: Associations between caregivers’ psychological distress and well-being while considering contextual factors
    J Müller, E Jansen, B Radlingmaier, J Hutchings, CL Ward, N Heinrichs, ...

MOST CITED SCHOLAR PUBLICATIONS

  • Effectiveness of internet‐delivered cognitive behavioral therapy for posttraumatic stress disorder: A systematic review and meta‐analysis
    M Sijbrandij, I Kunovski, P Cuijpers
    Depression and anxiety 33 (9), 783-791 , 2016
    2016.0
    Citations: 265
  • The bidirectional temporal relationship between parenting stress and child maltreatment: A cross-lagged study based on intervention and cohort data
    Q Han, R Jocson, I Kunovski, M Raleva, R Juhari, K Okop, A Oppler, ...
    Journal of affective disorders 354, 302-308 , 2024
    2024.0
    Citations: 20
  • Factor structure of the Depression, Anxiety and Stress Scale among caregivers in Southeastern Europe
    H Murphy, K Prandstetter, CL Ward, J Hutchings, I Kunovski, D Tăut, ...
    Family Relations 73 (2), 905-920 , 2024
    2024.0
    Citations: 17
  • Effects of childhood abuse and neglect on suicidal behavior in an adolescent clinical population
    I Kunovski, G Nikolova, A Filipovska, L Trpcevska, M Raleva
    European psychiatry 56, S65-S66 , 2019
    2019.0
    Citations: 12
  • Depression and anxiety in adolescents and their caregivers: A cross-sectional study from North Macedonia
    S Bajraktarov, I Kunovski, M Raleva, F Bolinski, R Isjanovska, G Kalpak, ...
    Prilozi 44 (1), 47-56 , 2023
    2023.0
    Citations: 7
  • Adverse event assessment in a parenting programme: experiences from a multisite randomised controlled trial
    I Frantz, HM Foran, JM Lachman, F Gardner, RJ McMahon, T Ogden, ...
    Trials 25 (1), 547 , 2024
    2024.0
    Citations: 4
  • Internet-delivered cognitive behavioral therapy for posttraumatic stress disorder in international humanitarian aid workers: Study protocol
    I Kunovski, T Donker, E Driessen, P Cuijpers, G Andersson, M Sijbrandij
    Internet interventions 10, 23-28 , 2017
    2017.0
    Citations: 2
  • Family-focused intervention programme to foster adolescent mental health and well-being: protocol for a multicountry cluster randomised factorial trial (FLOURISH Phase 2)
    A Piolanti, J Mueller, F Waller, N Heinrichs, J Simon, Y Shenderovich, ...
    BMJ open 15 (2), e094085 , 2025
    2025.0
    Citations: 1
  • Effectiveness of an online parenting program for childhood anxiety in North Macedonia
    I Kunovski, M Raleva
    Archives of Public Health 15 (2) , 2023
    2023.0
    Citations: 1
  • Six-country psychometric comparison of women responses to the Depression Anxiety Stress Scale (DASS) and the Child and Adolescent Behaviour Inventory (CABI) across cultures and …
    FAC Alfaro, J Lachman, CL Ward, Q Han, R Jocson, I Kunovski, ...
    Journal of Affective Disorders 387, 119524 , 2025
    2025.0
  • Does it get worse before it gets better? Outcomes from a parent-adolescen parenting program in North Macedonia
    I Kunovski, M Raleva, N Pachoska, M Bilinska, R Krsteska, ...
    2025.0
  • Provisional
    A Piolanti, J Mueller, F Waller, N Heinrichs, J Simon, Y Shenderovich, ...
    2024.0
  • COPING STYLES AND MENTAL HEALTH IN HEALTHCARE WORKERS DURING THE COVID-19 PANDEMIC
    I Kunovski, S Bajraktarov, V Isjanovski
    Academic Medical Journal 3 (3), 30-40 , 2023
    2023.0
  • Symptoms of depression and anxiety in adolescents and their caregivers: A cross-sectional study from North Macedonia
    I Kunovski, F Bolinski, M Raleva, R Isjanovska, G Kalpak, A Novotni, ...
    European Psychiatry 66 (Suppl 1), S201-S201 , 2023
    2023.0
  • Preventing Child Maltreatment and Promoting Family Wellbeing through Online Parent Support Groups in Six Countries
    Q Han, J Lachman, R Juhari, I Ferdinandi, M Raleva, R Jocson, ...
    Society for Prevention Research 30th Annual Meeting , 2022
    2022.0
  • Online Implementation of a Parenting Intervention for Parents of Children with Behavioural Problems: Implementation Data from a Multi-Site RCT in Southeastern Europe (RISE)
    D Taut, J Hutchings, A Baban, C Ward, N Heinrichs, H Foran, F Gardner, ...
    Society for Prevention Research 30th Annual Meeting , 2022
    2022.0
  • Parental Support through Promoting the Concept of Positive Parenting
    N Petrovska, NS Trajkovska, I Kunovski, AK Ristovska, S Georgievska, ...
    CONFERENCE PROCEEDINGS of the 1st International Conference–Challenges of … , 0
  • Family Functioning in low-resource settings: Associations between caregivers’ psychological distress and well-being while considering contextual factors
    J Müller, E Jansen, B Radlingmaier, J Hutchings, CL Ward, N Heinrichs, ...